How to get rid of a pain in the neck

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The neck is formed of the upper seven bones of the spinal column, called the cervical vertebrae. These are linked together by small joints that work with the neck muscles to allow the head to move in different directions. Picture: BaileyRaeWeaver, flickr.com

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London - Neck pain is depressingly common - a new Danish study of nearly 5,000 people suggests that during a typical fortnight, one in five women and more than one in ten men will complain of it.

Bad design makes the neck particularly vulnerable to problems. Because we need our heads to rotate, stability and robustness have been sacrificed for mobility. And our heads weigh on average around five kilograms, which puts a continual strain on the neck’s delicate structures.

The neck is formed of the upper seven bones of the spinal column, called the cervical vertebrae. These are linked together by small joints that work with the neck muscles to allow the head to move in different directions.

Spongy discs between the bones act as shock absorbers, and nerves and arteries run down the neck into the rest of the body. With so much going on in a relatively small area, it’s not surprising things can easily go wrong.

Neck pain usually lasts less than a fortnight, and can be treated with painkillers. The best option is those that reduce inflammation, such as ibuprofen. Physiotherapy or heat treatment to dampen any inflammation may also be helpful, and in some cases surgery may even be needed.

‘To prevent weakening of the neck muscles, we recommend people with neck pain don’t rest for more than a few days, and start some simple exercises as soon as the pain starts to ease,’ says Professor Alan Silman, medical director of Arthritis Research UK.

‘These will help restore range of movement, promote strength, ease stiffness and help get it back to normal.’

Here we reveal the common causes of neck pain, and how to treat them.

NECK PAIN WITH TINGLING FINGERS

Other symptoms: Pain in the arms and hands; pain that spreads from the back of the head to the front; dizziness.

Probable cause: Cervical spondylitis, or arthritis of the neck, which affects, to some degree, an estimated 90 percent of adults by the age of 60.

Here, age-related wear and tear leads to damage of the discs or bones of the neck. The discs can then split or bulge, pressing on nerves in the neck.

Furthermore, the body tries to repair any damage to the bone by adding new bits of bone - which can exacerbate the problem, as these bony outcrops can trap nerves. If this affects nerves leading to the head and arms, it can trigger head pain as well as numb arms and hands.

In extreme cases, arteries can become compressed, reducing blood supply to the brain, causing dizziness.

Professor Silman says you are more likely to develop the condition if your parents also suffered with it. ‘Research has shown that inherited factors affect normal wear and tear,’ he says. ‘However, most of this type of neck pain is not due to a serious or obvious underlying condition.’

Treatment: Gentle exercise such as swimming and walking can help by strengthening muscles in the neck, which help support the damaged joints. In extreme cases, surgery may be needed to remove excess bone or trim away a part of the bulging disc, relieving any pressure on trapped nerves.

ONE-SIDED STIFFNESS

Other symptoms: Pain on movement, that may spread to the back of the head and shoulders.

Probable cause: Wry neck, or acute torticollis, is caused when the neck has been held in an uncomfortable, twisted position for a long time, such as during sleep or sitting at a computer.

It can also occur in cold temperatures, or if you sit in a draught. It is thought the cold or unusual position may lead to irritation, or to a minor sprain of the muscle or ligaments (the fibrous tissue that connects bones to other bones).

Treatment: The condition usually eases over one or two days, and during this time you should keep the neck mobile.

Gently move the neck in each direction every few hours. Heat packs applied to the affected area have also been shown to be effective by relaxing muscles. In severe cases, you may be prescribed a muscle relaxant, such as diazepam.

A firm supporting pillow while sleeping can help reduce the risk of recurrence, as can exercise that improves muscle strength around the neck and shoulders, such as yoga and pilates.

STIFF NECK AND A HEADACHE

Other symptoms: Head pain that starts at the base of the neck and slowly moves into the head; pain in the arm; neck stiffness.

Probable cause: Cervogenic neck pain - a headache due to problems in the neck - accounts for 15 to 20 percent of all headaches, according to a study in the International Journal of Sports Physical Therapy.

‘Most of our chronic headache patients also have neck pain,’ says Dr Andrew Dowson, director of headache services at King’s College Hospital, London.

One theory is that the pain is transferred from the base of the neck through occipital nerves, which travel up either side of the neck to the top of the head.

The pain can arise from a number of causes, such as wear and tear in the bones of the neck, or the discs between the bones of the neck bulging and compressing nerves.

The compression of the nerves can lead to pain along the arms.

The condition can be made worse by muscle tension in the neck and shoulders.

Treatment: Exercises that strengthen the neck muscles can be beneficial, but if these don’t provide relief after a couple of months, doctors sometimes inject steroids into the tissue around the nerves in the neck, which helps reduce inflammation.

If these fail to work, then nerve-block jabs can prevent pain signals being sent from the nerves in the neck.

Both treatments require referral to a specialist.

NECK PAIN WITH EARACHE

Other symptoms: Dull ache in the neck, especially around the sides; sore throat; hearing loss or tinnitus.

Probable cause: Ear infection, or specifically otitis media, which affects the middle ear, the area just behind the eardrum. This usually starts with a cold, and happens when the Eustachian tubes, which connect the middle ear to the nose, become blocked.

Mucus, pus and bacteria can also pool behind the eardrum, causing pressure and pain. These infections can cause the lymph glands in the neck to swell, which can trigger neck pain.

Treatment: Ear infections of most kinds clear up on their own. However, if there is no improvement after 24-48 hours, then call your GP as antibiotics may be needed.

STIFF NECK WITH SHOULDER PAIN

Other symptoms: Muscle spasms in the neck; pain in the arms or back of the head.

Probable cause: Whiplash, which is caused by a sudden movement of the head forwards, backwards or sideways, and is most commonly associated with vehicle accidents, although it can be the result of a fall or a blow to the head. Sudden, forceful movements can damage neck ligaments and tendons that connect muscle to bone.

Treatment: The average recovery time for a whiplash injury is 32 days, according to an NHS study.

‘Gentle exercises to keep the neck mobile will help prevent longer-term problems,’ says Professor Silman. Physiotherapy can also be useful in restoring movement, by strengthening damaged structures.

Painkillers that reduce inflammation, such as ibuprofen, can help, but stronger prescription pain relief may be necessary.

NECK PAIN WHEN YOU WAKE UP

Other symptoms: Severe stiffness and pain, usually worse in first hour after waking; a crunching feeling when neck is moved.

Probable cause: Rheumatoid arthritis, which is caused when the body attacks healthy tissue in the joints, affects 700,000 adults in the UK.

Usually the condition is confined to hands and wrists, though in some people it can affect the joints between the bones in the neck.

‘Drug treatments have transformed the care of these patients, but we still see significant problems affecting the neck where joints in the neck have been eroded, causing painful trapped nerves,’ says Ian Harding, consultant spinal surgeon at Frenchay Hospital and the Spire Hospital, Bristol.

Treatment: There is no cure, but several drug treatments are available that dampen down the excessive immune system to reduce inflammation and pain.

‘Surgery certainly has a role to play in the care of these patients,’ adds Mr Harding, - Daily Mail

www.arthritisresearchuk.org

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